93 Decision Citation: BVA 93-04326
Y93
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 90-53 060 ) DATE
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Sitting at Togus, Maine
THE ISSUE
Entitlement to an increased rating for aortic valve disease,
status post aortic valve replacement, currently rated
30 percent disabling.
REPRESENTATION
Appellant represented by: Bureau of Veterans Services,
Maine
WITNESS AT HEARING ON APPEAL
Appellant
INTRODUCTION
The appellant had active military service from August 1961
to August 1965.
This matter comes before the Board of Veterans' Appeals
(Board) on appeal from an April 1989 rating action by the
Togus, Maine, Regional Office (RO) of the Department of
Veterans Affairs (VA) which denied an increase in a 30
percent disability rating for service-connected aortic valve
disease. The appellant's notice of disagreement was
acknowledged by the RO in May 1989, and a statement of the
case was issued to him in May 1989. A supplemental
statement of the case was issued in April 1990, and the
appellant's substantive appeal was submitted in a timely
manner by him in May 1990. Another supplemental statement
of the case was issued in October 1990.
In November 1990, the appellant and his representative
appeared at a hearing held before a traveling section of the
Board, sitting at Togus, Maine. The case initially arrived
at the Board in December 1990.
In May 1991, the Board remanded this appeal to the RO for
further development. A supplemental statement of the case
was issued in December 1991, and the case was returned to
the Board in April 1992. Additional records were received
by the Board in November 1992. Throughout this appeal, the
appellant has been represented by the Bureau of Veterans
Services of the State of Maine.
CONTENTIONS OF APPELLANT ON APPEAL
The appellant contends that the RO should have assigned a
rating higher than 30 percent for his service-connected
aortic valve disease, status post aortic valve replacement.
He contends that his heart disability has increased in
severity since replacement of the aortic valve, and that he
is no longer able to hold such jobs as truckdriver or
machinist which he has traditionally held in the past.
DECISION OF THE BOARD
In accordance with the provisions of 38 U.S.C.A. § 7104
(West 1991), following review and consideration of all
evidence and material of record in both volumes of the
veteran's claims file, and for the following reasons and
bases, it is the decision of the Board that the evidence
supports the assignment of an increased rating of 60 percent
for the postoperative residuals of an aortic valve
replacement.
FINDING OF FACT
As a result of the veteran's service-connected valvular
heart disability, more than light manual labor is precluded.
CONCLUSION OF LAW
The criteria for a 60 percent evaluation for aortic valve
disease, status post aortic valve replacement, are met.
38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4,
§ 4.7, Codes 7000, 7016 (1991).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
Initially, we find that the appellant's claim is well
grounded, and that VA has fulfilled its duty to assist the
appellant in the development of his claim. 38 U.S.C.A.
§ 5107(a).
Disability evaluations are determined by the application of
VA's Schedule for Rating Disabilities (Rating Schedule),
38 C.F.R. Part 4. The percentage ratings contained in the
Rating Schedule represent, as far as can be practicably
determined, the average impairment in earning capacity
resulting from diseases and injuries incurred or aggravated
during military service and their residual conditions in
civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1.
By rating action dated in 1972, service connection for
valvular heart disease was established. A 30 percent
disability rating was assigned for that service-connected
disability from February 1972 to October 1987. During that
period of time, the veteran gradually developed congestive
heart failure secondary to his aortic insufficiency. In
October 1987, he was hospitalized complaining of severe
chest pains. Clinical testing established the need for
surgical replacement of the aortic valve, which was
accomplished in January 1988. For approximately the first
eight months following surgery, the veteran appeared to be
making a good recovery; afterwards, however, there were
increasing complaints by the veteran of heart palpitations
and shortness of breath. Between October 1987 and March 1,
1989, temporary total ratings under 38 C.F.R. §§ 4.29 and
4.30, followed by a 100 percent schedular rating under
Diagnostic Code 7016 of the Rating Schedule were in effect.
According to the Rating Schedule, the veteran's service-
connected heart disability should be subsequently rated
under the provisions of Diagnostic Code 7000, with a minimum
rating of 30 percent. 38 C.F.R. Part 4, Code 7016.
Under the provisions of Diagnostic Code 7000, a 30 percent
disability rating will be assigned with clinical evidence of
a diastolic murmur with characteristic electrocardiogram
manifestations or a definitely enlarged heart. The next
higher rating of 60 percent will be assigned where the heart
is definitely enlarged, with evidence of severe shortness of
breath on exertion, elevation of systolic blood pressure, or
such arrhythmias as paroxysmal auricular fibrillation or
flutter or paroxysmal tachycardia; and where more than light
manual labor is precluded. 38 C.F.R. Part 4, Code 7000.
In our review of the evidence of record, we have noted that
a gated radionuclide ventriculogram administered to the
veteran in January 1990 was interpreted as revealing severe
left ventricular hypertrophy and a resting ejection fraction
which was above the upper limit of normal. In April 1990,
the veteran was treated for an episode of bacterial endocard-
itis. On an echocardiographic stress test administered to
the veteran in September 1991, there was evidence of abnormal
segmental wall motion with a mildly reduced ejection fraction
and exaggerated apicoseptal wall motion abnormality. An
exercise treadmill test administered in the same month
revealed more frequent premature ventricular contractions
with couplets during exercise; this exercise treadmill test
also had to be terminated prematurely due to general fatigue
and shortness of breath of the veteran. A 24-hour Holter
monitor administered to the veteran, also in September 1991,
revealed one episode of ventricular bigeminy. Other echo-
cardiograms administered to the veteran at various times
also show some evidence of aortic valve insufficiency.
In our judgment, the evidence is at least equally divided on
whether there are manifestations of service-connected
valvular heart disease which more nearly approximate the
criteria for the next higher rating, and under such
circumstances the benefit of the doubt is to be given to the
veteran. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 4.7. We
hold that signs and symptoms of the heart disorder are of a
severity that more than light manual labor would be
precluded, and a 60 percent schedular rating is warranted.
The veteran's symptoms are insufficient to justify either the
assignment of a 100 percent schedular rating under Diagnostic
Code 7000 or the assignment of a total rating on the basis
of individual unemployability.
ORDER
A 60 percent rating for aortic valve disease, status post
aortic valve replacement, is granted, subject to the laws
and regulations governing the effective dates of awards.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
*
D. P. DEAN W. H. YEAGER, JR., M.D.
L. W. TOBIN
*This individual was designated as an acting board member
under the authority of 38 U.S.C.A. § 7102 when the hearing
was held, and he participated in the deliberations; however,
his designation as an acting board member has expired and
has not been renewed. 38 U.S.C.A. § 7102(a)(2)(A) (West
1991) permits a Board of Veterans' Appeals Section, upon
direction of the Chairman of the Board, to proceed with the
transaction of business without awaiting assignment of an
additional Member to the Section when the Section is
composed of fewer than three Members due to absence of a
Member, vacancy on the Board or inability of the Member
assigned to the Section to serve on the panel. The Chairman
has directed that the Section proceed with the transaction
of business, including the issuance of decisions, without
awaiting the replacement of this individual.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991), a decision of the Board of Veterans' Appeals granting
less than the complete benefit, or benefits, sought on
appeal is appealable to the United States Court of Veterans
Appeals within 120 days from the date of mailing of notice
of the decision, provided that a Notice of Disagreement
concerning an issue which was before the Board was filed
with the agency of original jurisdiction on or after
November 18, 1988. Veterans' Judicial Review Act, Pub. L.
No. 100-687, § 402 (1988). The date which appears on the
face of this decision constitutes the date of mailing and
the copy of this decision which you have received is your
notice of the action taken on your appeal by the Board of
Veterans' Appeals.